Provider Demographics
NPI:1164035341
Name:WILLIAM M COLBURN DMD PC
Entity Type:Organization
Organization Name:WILLIAM M COLBURN DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:MANLEY
Authorized Official - Last Name:COLBURN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:205-339-1777
Mailing Address - Street 1:2810 20TH AVE STE A
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:AL
Mailing Address - Zip Code:35476-3835
Mailing Address - Country:US
Mailing Address - Phone:205-339-1777
Mailing Address - Fax:
Practice Address - Street 1:2810 20TH AVE STE A
Practice Address - Street 2:
Practice Address - City:NORTHPORT
Practice Address - State:AL
Practice Address - Zip Code:35476-3835
Practice Address - Country:US
Practice Address - Phone:205-339-1777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-26
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental